The Referral Specialist impacts reimbursement through obtaining accurate referral and authorization information from provider offices, patient’s, and insurance carriers for all MMA providers.
This position is responsible for obtaining required insurance information to ensure timely payment, using appropriate electronic tools.
High School diploma or equivalent required. Certificate of Completion of medical assistant program required.
Training & Experience:
Minimum of three years experience as a medical assistant is required. Two years insurance referral experience required. Must have knowledge in Allscripts, Internet, and have excellent phone skills.
Must have a working knowledge of ICD-9-CM and CPT-4, keyboarding, computer operation skills to include internet knowledge, excel and word.
1. OBTAIN REFERRALS AND AUTHORIZATIONS
1. Obtain intake information from provider offices.
2. Contact Insurance Carriers for approval of visit(s).
3. Contact specialist’s offices.
4. Communicate with patients.
5. Responds to internet, EHR clinical messages, telephone and fax from referral sources
6. Resolves patient complaints by identifying problems.
7. Must be flexible, able to adapt to changes in work volume and scheduling.
2. DEPARTMENTAL REQUIREMENTS
1. Promotes protection of patient confidentiality in all phases of work.
2. Continuing education – maintains continuous professional development through attending seminars
and other educational meetings.
3. Demonstrates job related aspects of patient safety to assure a safe environment, safe and effective use of equipment and technology and decreased risk of potential adverse patient occurrences.
4. Demonstrates knowledge of and supports hospital mission, vision value statements, standards, policies and procedures, operating instructions, confidentiality standards, the code of ethical behavior and corporate compliance plan.
5. Assists with training/orientation of new employees and students.
6. Relates to the needs of the department by accepting additional assignments which may or may not be related to primary responsibilities to ensure the continuity of department services and to provide teamwork.
7. Communicates appropriate information to co-workers and Manager in a timely and accurate manner.